Treatment

Pregnancy

All pregnant smokers should be strongly encouraged to stop smoking throughout the entire length of their pregnancy. Cutting down the amount smoked is NOT sufficient. All pregnant smokers should be offered, at the very least, a minimal intervention (See below). Whenever possible, intensive counseling is recommended. It's never too late to quit smoking during pregnancy. Health benefits, for both the mother and fetus, can be obtained throughout the entire 9 months.

The same behavioral interventions that have been shown to be effective with all smokers should be applied to the pregnant smoker. Remember the Five A's:

1. Ask every pregnant women about smoking -- some pregnant women may try to hide their smoking status or try to minimize their use.
2. Advise every pregnant women to quit early since this benefits the mother and fetus most. Quitting anytime (even late in pregnancy) will benefit both the mother and fetus.
3. Assess willingness to make a quit attempt.
4. Assist every pregnant woman by providing motivational messages, such as:
   "This is the most important gift you, as a new mother, can give to your baby. It will be important to stay quit after your baby is born. Remaining smoke-free will keep your baby healthy. I would like to help you stop smoking today".
5. Arrange for follow-up to assess progress. Congratulate successes -- remind the woman that she is truly helping herself and her baby. Incorporate relapse prevention strategies since postpartum relapse rates are high even if a women maintains abstinence during pregnancy.

To date, nicotine replacement, as a form of treatment, has not been systematically evaluated among pregnant smokers. According to the 1996 AHCPR [now Agency for Healthcare Research and Quality (AHRQ)] Smoking Cessation Clinical Practice Guideline, nicotine replacement should be used during pregnancy only if the increased likelihood of smoking cessation, with its potential benefits, outweighs the risk of nicotine replacement and potential concomitant smoking.